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Vinay Prasad, MD MPH 🎙️📷 Profile picture
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16 Dec, 4 tweets, 2 min read
Now out in @EJCI_News
Logan Powell & I show where randomized trials necessary

When people say 'we don't need an RCT of smoking (to prove harm) or parachutes (to prove benefit)' does that apply to widespread medical interventions?
🧵
onlinelibrary.wiley.com/doi/10.1111/ec…
1 @vkprasadlab
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More from @VPrasadMDMPH

Vinay Prasad, MD MPH 🎙️📷 Profile picture
14 Dec
Led by Timothee Olivier, our new paper is now out at @JAMANetworkOpen

We analyze 12 years of FDA approvals, and do the hard work of sorting them into
New Mechanism of Action (MOA)
& New MOA for that tumor type
Vs next in class

jamanetwork.com/journals/jaman…
First we find, more drug approvals over time!

More approvals means more innovation, right?
Next we show how many drug approvals are truly innovative

The dark bar shows the first approval of a new MOA across tumor types, or within a tumor type (bottom pane)

(bottom pane) the brown bar is moving to an earlier line
light blue = next in class
Read 7 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
11 Dec
Few prelim thoughts on this trial (from quick read)
#ASH21
1. It is not a 'second line' trial, it is a trial in the worst subset of second line pts & cannot extrapolate beyond

Primary refractory & relapse <12 mo

(TBH, a lot of people doing this already) Image
As such, it should not generalize to relapse > 12 months

2. That said, for those included, axi-cel seems preferable to chemo then auto; I am not surprised this is true in the most chemo insensitive biology. But a few more thoughts Image
3. This is Wrong, you are not supposed to do this 👇👇
Standard practice is to take these pts to CAR-T if needed in the control arm; thus, you must compare routine, upfront CAR-T to using CAR-T as salvage when indicated and standard of care.

And you don't adjust for it Image
Read 9 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
30 Nov
Every time you add a dose of vax
from 1 to 2
2 to 3
3 to 4

you have some increased risk of myocarditis leading to hospitalization (for sure)

& possibly, some lower risk of being very sick with covid

How do we weigh these?
🧵
Of course good vaccine approvals occur when:

the reduction in risk of bad covid outcomes from getting 1 more dose is
> (Greater than)
the risk of bad vaccine outcomes from getting 1 more dose

This must be re-calculated with each dose
There is uncertainty around both estimates

We know the rate of myocarditis after dose 2 in these ages (1 in 5-10k), but not dose 3

We know the risk of hospitalization at these ages among unvaccinated

That risk falls with 1 dose; it falls a bit more with 2
Read 13 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
3 Oct
All these people 👇 are lying about the content of my piece & tagging my employer @UCSFHospitals

My piece which anyone can read: vinayprasadmdmph.substack.com/p/how-democrac…

Is about a future scenario where pandemic precedents may subvert democracy

Its not a Holocaust analogy

Why do they lie?🧵
The piece clearly states it is not about the present, but the future

A series of events that might happen, but has not yet occurred....
It describes 7 key factors which are vulnerabilities in our pandemic response where democracy can be threatened in the future

this is more likely to come from the counter party (i.e. the group that opposed these things this time)
Read 8 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
1 Oct
Led by UCLA chief resident @uclaimchiefs Jack Sharp & with my friend @arkhaki our NEW paper is now OUT in @JAMANetworkOpen!! @vkprasadlab

Check it out 👇👇🧵

We analyze second line therapies in trials that seek to replace sunitinib as front line RCC Rx
jamanetwork.com/journals/jaman… Image
These are the 6 studies we focus on
They will be no surprise to RCC folks

Our question is simple:

Did pts assigned to the control arm get appropriate post protocol care?

I pray the answer is yes! Image
Here is the key figure 👇👇👇

Let me walk you through it... Image
Read 10 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
29 Sep
Just like the examples in this article, celebrating that working class people are being fired over vaccine mandates is not my idea of progressivism

Losing a job in America is a serious punishment and many of these people worked hard for many years...

vinayprasadmdmph.substack.com/p/progressivis…
... many of these people who are losing their jobs right now risk their own personal safety to work in the hospital before there was a vaccine. When you needed them.

These people don't disappear from America either, and their fate is tied to all our fate.
Pressuring people to get vaccinated will increase vaccination rate some fraction and that will provide some marginal extra protection to people who've already chosen to be vaccinated, but it will also lead to firings and that will provide negative countervailing results..
Read 4 tweets

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